A comprehensive network meta-analysis evaluating poly (ADP-ribose) polymerase (PARP) inhibitor (PARPi) regimens in BRCA-mutated ovarian cancer has found no statistically significant differences in efficacy or toxicity among various treatment approaches. The study, which included patients responsive to front-line platinum or platinum-sensitive relapsed disease, compared regimens such as bevacizumab and olaparib, veliparib and chemotherapy, and olaparib monotherapy in the upfront setting, as well as olaparib, rucaparib, and niraparib in the relapsed setting.
The research utilized data from phase III randomized controlled trials to generate direct and indirect comparisons. The primary outcomes assessed were progression-free survival (PFS) in the BRCA mutation cohort and the incidence of grade 3–4 adverse events. The American Society of Clinical Oncology (ASCO) value framework was employed to evaluate the cost-effectiveness of the PARPi regimens.
Efficacy and Safety Profiles
The network meta-analysis indicated that the 95% confidence intervals for both efficacy and toxicity comparisons included 1, suggesting no significant differences between the assessed PARPi regimens. This finding implies that the choice of PARPi regimen may depend on factors other than superior efficacy or reduced toxicity, such as cost and patient preference.
Cost-Effectiveness Analysis
The ASCO value framework revealed that current PARPi regimens have similar clinical benefits, toxicity profiles, and net health benefits in both upfront and relapsed settings. However, the addition of bevacizumab to olaparib increased the cost per unit net health benefit for patients ($353.72) compared with olaparib monotherapy ($260.57). This suggests that while the combination may offer clinical benefits, the incremental cost may not be justified for all patients.
Toxicity Considerations
Interestingly, the study found that upfront PARPi regimens had lower toxicity scores than the regimens used at relapse. This observation could influence treatment decisions, particularly for patients who may be more sensitive to adverse events.
The study highlights the importance of considering cost-effectiveness and toxicity profiles when selecting PARPi regimens for BRCA-mutated ovarian cancer patients. While the efficacy appears similar across different regimens, the economic and safety implications may vary, influencing personalized treatment strategies.
